Child mortality remains a great challenge in Madagascar. Every year, some 44,000 children, or 120 every day, still die before their fifth birthday. They die from causes we can prevent – from pneumonia (21 per cent), malaria (20 per cent), and diarrhea (17 per cent). In addition, an estimated 26 per cent of infant deaths occur during the first month of life due to neonatal complications.
Madagascar’s overall health system is poor, especially following the long crisis after the 2009 political coup d’état. There is great lack of access to health care in remote rural regions, where many women and children are left without basic, life-saving social services. Many children do not receive routine immunizations, such as polio, tetanus, measles, and tuberculosis. Medical care is expensive relative to the average Malagasy income, and there is an extremely low rate of trained medical professionals, especially in rural areas. In 2012 alone, over 200 health centers closed their doors due to lack of personnel.
Maternal health is poor, and maternal mortality is high. Every year, 3,000 women, or 8 each day, die as a result of pregnancy related causes. An estimated 44 per cent of women receive delivery assistance from a trained professional, but only 4.1 per cent of deliveries take place in newborn facilities. The caesarean rate is only 1.5 per cent, compared to the accepted minimum of 5 per cent. The quality of services is also very poor. Maternal death audit – an indispensable tool to improve the quality of emergency obstetric care – is not practiced anywhere in Madagascar.
As Madagascar emerges from over three years of political crisis, and in order to overcome the increasing gaps in Health and Nutrition, UNICEF has teamed with the European Union to strengthen the health system with a focus on five regions of Madagascar. Access to health will be improved particularly in the regions of Sava, Analanjirofo, Menabe, Atsimo-Andrefana and Anosy. The funding will help train and recruit additional specialist staff and re-equip health centers in the most inaccessible areas, and enable the country to move forward on the path of development. This health system strengthening support will expand to four additional regions in 2014 making a total of 9 out of the 22 regions in the country covering about 50% of the total population.
To combat malaria, UNICEF supports the national distribution of insecticide treated mosquito nets. UNICEF provides children and pregnant mothers with anti-malaria drugs during check-ups, and also provides training for Community Health Workers to improve access to essential treatment services for children. The training programme, also called Integrated Community Case Management of Childhood Illnesses, focuses on diagnosing and treating pneumonia, diarrhea and malaria, the largest killers of children under 5. Through the programme, community health workers help treat the three major killers of children and conduct home visits for health education. The community health workers’ role is becoming more important as the government struggles to address health workforce shortages.
To reduce neonatal and maternal mortality, community health workers are trained in emergency obstetric care. They are trained to provide vital care to women facing complicated pregnancies and to prevent newborn infections. Due to limited funding this essential intervention is limited to three out of 112 districts for the moment. These interventions need to be scaled up to ensure impact. The application of an antiseptic called chlorhexidin has proven to reduce new born mortality and will need to be added to the package.
To improve routine vaccination coverage, UNICEF’s support includes strengthening the cold chain to transport the vaccines safely to remote reach villages. UNICEF also provides funding to purchase vaccines to fill gaps due to lack of funds from the government, and to train staff on vaccination techniques and cold chain maintenance. With logistics support, outreach community workers help vaccinate children in remote and isolated villages. With support to the Government, low vaccination coverage zones are identified in order to reach children in the most remote parts of the country.
A vital part of UNICEF’s program on health and nutrition is the twice yearly Mother and Child Health week. Each year, for a week in April and in October, teams of outreach workers travel across Madagascar, bringing a host of low-cost, high-impact interventions to pregnant women and millions of children under the age of five. These include immunizations, Vitamin A supplementation, de-worming, nutrition screening and HIV screening in the prevention of mother to child transmission of HIV/AIDS. The specific objective of the twice yearly National Child Health Weeks is to reach at least 90 percent of eligible children under five years of age. As government budgets have been cut, UNICEF has funded an ever-greater portion of this essential campaign. In 2012, UNICEF funded more than 95 per cent of the campaign. For 2013 the Health Weeks are combined with the catch-up measles campaign that will help avert a measles outbreak among over 800,000 susceptible children. Since the 2010 campaign UNICEF provided over 67% of the 4 million dollars needed for this activity.